Objective:

To report a rare case of distal renal tubular acidosis (dRTA) induced by tislelizumab, an immune checkpoint inhibitor.

Approach:

Key Findings:

• The patient experienced life-threatening hypokalemia (serum potassium nadir 1.1 mmol/L) and profound metabolic acidosis (CO2-CP nadir 11.6 mmol/L).
• Urine pH was 7.0 during systemic acidosis, indicating impaired renal acidification characteristic of dRTA.
• After treatment, the patient maintained normal renal function and achieved a major partial response of his lung cancer over one year of follow-up.

Interpretation:

Limitations:

• The diagnosis was based on clinical presentation and laboratory findings without renal biopsy due to the patient's critical condition.
• The case is a single report, limiting generalizability.

Conclusion:

Tislelizumab can induce dRTA, a rare but serious immune-related adverse event.

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